Abstract
Background: Whether diminished pulsatility influences outcomes in patients with continuous-flow left ventricular assist devices (CF-LVAD) is largely undetermined. We sought to characterise the relationship between measured flow pulsatility and outcomes in patients with a HeartWare CF-LVAD (HVAD). Methods: Log-files from 61 HVAD patients with pulsatility data were analysed. Mean, peak, trough flow and pulsatility (peak – trough flow) were extracted. A flow pulsatility index (PI) (pulsatility/mean flow) was calculated for each patient at 1, 3, 6, 9 and 12 months from HVAD patient log files. Patients were divided into tertiles reflecting low, intermediate and high pulsatility based on their average PI. Baseline demographics and outcomes were compared between groups. Outcomes compared were gastrointestinal bleeding (GIB), neurological events (NE) and pump thrombus (PT). Results: Patients were divided into tertiles reflecting low (n = 21), intermediate (n = 19) and high (n = 21) pulsatility. There were no significant differences in demographics between groups according to pulsatility. Surprisingly, PT rates were significantly higher (p = 0.013) in the high pulsatility (n = 6, 29%) group compared to the low (n = 0, 0%) and intermediate (n = 1, 5%) groups. Binary logistic regression yielded low trough flow as an independent predictor of PT (OR 0.205, p = 0.028). NE (p = 0.113) and GIB (p = 0.607) did not differ significantly between groups. Conclusion: Flow PI was positively associated with PT, likely due to an effect of low trough flow. This presents an important potential target for future therapeutic intervention.
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